| NPI | 1407839574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: KS 1147) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 1147) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2024-09-23 |