| NPI | 1356406060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1075) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: KS 1075) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KS 1075) | |
| 103TF0200X Psychologist, Forensic (Licence: KS 1075) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: KS 1075) | |
| 103T00000X Psychologist (Licence: KS 1075) | |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2021-04-30 |