| NPI | 1083736540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 952) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103T00000X Psychologist (Licence: CO 952) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2023-09-04 |