| NPI | 1275365124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0006485) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CO PSY.0006485) |
| 103TH0100X Psychologist Health Service (Licence: CO PSY.0006485) | |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-19 |