| NPI | 1568113389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0005949) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2022-10-13 |