| NPI | 1194387514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005078) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1273) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2019-09-27 |