| NPI | 1295211472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0006817) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CO 0006817) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2025-09-09 |