| NPI | 1275834533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS 1974) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: KS 1974) |
| 103TP2701X Psychologist Group Psychotherapy (Licence: KS 1974) | |
| 103TF0000X Psychologist Family (Licence: KS 1974) | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: KS 1974) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: KS 1974) | |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2011-07-26 |