| NPI | 1518022904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 0156) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 0266) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2013-04-10 |