| NPI | 1386295277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY5175) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSYC13966) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2020-03-30 |