| NPI | 1447035118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSYC.00015484) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2024-01-18 |