| NPI | 1336865856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KS 03176) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: KS 03176) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2026-07-30 |