| NPI | 1235346743 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1444) | 
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KS 1444) | 
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: KS LCAC00846) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: 1444) | |
| Enumeration Date | 2007-05-16 | 
| Last Update Date | 2025-09-05 |