| NPI | 1598489270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CO PSY.0006384) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2024-07-10 |