| NPI | 1114033131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 2193) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CO 2193) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO 2193) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2025-09-11 |