| NPI | 1235346743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1444) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: KS LCAC00846) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KS 1444) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: 1444) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-09-15 |