| NPI | 1679652184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY0002871) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: UT 65825010) |
| 103TH0100X Psychologist, Health Service (Licence: KY 870) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-06-08 |