| NPI | 1033277421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 1153) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 1153) |
| 103TC0700X Psychologist, Clinical (Licence: CO 1153) | |
| 103TF0200X Psychologist, Forensic (Licence: CO 1153) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CO 1153) | |
| 103TS0200X Psychologist, School (Licence: CO 344980) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2007-07-08 |