| NPI | 1447754304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005881) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 37685) |
| 103TF0200X Psychologist, Forensic (Licence: TX 37685) | |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-12-14 |