| NPI | 1982378527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KS 03046) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2954) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2022-04-04 |