| NPI | 1295194017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: CO PSY.0004362) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 37069) |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2016-02-22 |