| NPI | 1508055518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0006979) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 4151) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2026-01-28 |