| NPI | 1205428323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY.0002439) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CO 2439) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-03-09 |