| NPI | 1417171869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 0726) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: KS 316) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |