| NPI | 1205833449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY0005723) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY0005723) |
| 103TC1900X Psychologist, Counseling (Licence: CO PSY0005723) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY0005723) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2026-05-19 |