| NPI | 1669963427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0004586) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IA 088595) |
| Enumeration Date | 2018-05-28 |
| Last Update Date | 2018-12-20 |