| NPI | 1881584159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 03448) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1930) |
| Enumeration Date | 2025-07-08 |
| Last Update Date | 2025-07-31 |