| NPI | 1417175019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AZ PSY003500) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO PSY.0002589) |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2024-01-16 |