| NPI | 1225147085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 301) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: KS 301) |
| 103TF0200X Psychologist, Forensic (Licence: KS 301) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2013-06-21 |