| NPI | 1700983368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KS 610) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 610) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: KS 610) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: KS 610) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: KS 610) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: KS 610) | |
| 103TF0000X Psychologist Family (Licence: KS 610) | |
| 103TF0200X Psychologist Forensic (Licence: KS 610) | |
| 103TH0100X Psychologist Health Service (Licence: KS 610) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: KS 610) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2022-08-30 |