| NPI | 1083642482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0003029) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CO 3553) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-04-25 |