| NPI | 1568740462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY0004400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 0004400) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2018-03-17 |