| NPI | 1215092721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0700X Psychologist Adult Development & Aging (Licence: KS 859) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: KS 859) |
| 103TC0700X Psychologist Clinical (Licence: KS 859) | |
| 103TF0200X Psychologist Forensic (Licence: KS 859) | |
| 103T00000X Psychologist (Licence: KS 859) | |
| 103TP0814X Psychologist Psychoanalysis (Licence: KS 859) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: KS 859) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |