| NPI | 1063400851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0003103) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 00194) |
| 103TC0700X Psychologist, Clinical (Licence: IA 00072) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2016-04-13 |