| NPI | 1952370942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 1372) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AK 492) |
| 103T00000X Psychologist (Licence: MO 2005036331) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2019-03-25 |