| NPI | 1326823295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0006240) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO PSYC.00015119) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2023-10-11 |