| NPI | 1346635141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.006454) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 10783609-2501) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2025-08-07 |