| NPI | 1669008868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ PSY-005603) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO NLC.0107000) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2023-08-08 |