| NPI | 1619326451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004951) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2024-02-26 |