| NPI | 1598795304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS KS#746) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS KS LP #0746) |
| 103T00000X Psychologist (Licence: MO PY01331) | |
| 103T00000X Psychologist (Licence: MO MO#PY01331) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2021-10-05 |