| NPI | 1801905682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: KS 1321) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2004013228) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-05-05 |