| NPI | 1114941317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS LP-0449) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KS LP-0449) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-10-13 |