| NPI | 1396891149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005694) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 32430) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2023-03-10 |