| NPI | 1477604130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 1286) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2004024736) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2023-05-31 |