| NPI | 1063801579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004746) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0004746) |
| 103T00000X Psychologist (Licence: FL PPY 200) | |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2024-04-24 |