| NPI | 1487497830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 1113) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: CO 1113) |
| 103T00000X Psychologist (Licence: CO 1113) | |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2024-06-14 |