| NPI | 1558979104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 01529) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 3026) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2025-07-24 |