| NPI | 1184958126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS LMLP-1351) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS T-LMLP1297) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2013-04-12 |