| NPI | 1437240207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 899) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 0217) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-13 |