| NPI | 1477010601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO 00014485) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| 103TS0200X Psychologist, School (Licence: CO 357926) | |
| 103T00000X Psychologist | |
| Enumeration Date | 2019-02-24 |
| Last Update Date | 2021-02-24 |