| NPI | 1033397351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 4267) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 1321) |
| 103TC1900X Psychologist, Counseling (Licence: CO PSY.0004267) | |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2019-10-15 |