| NPI | 1124750997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005822) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.000582) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-04-16 |