| NPI | 1013462639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0006278) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KS 2436) |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2026-03-20 |