| NPI | 1053700344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1385) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CO 1385) |
| 103TH0100X Psychologist, Health Service (Licence: CO 1385) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CO 1385) | |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2015-01-09 |