| NPI | 1184634966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 599) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS 599) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: KS 599) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2007-07-08 |