| NPI | 1235455965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005774) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY8053) |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2023-07-17 |