| NPI | 1033731609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY.0005276) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging |
| Enumeration Date | 2020-05-17 |
| Last Update Date | 2022-09-22 |