| NPI | 1699822064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY 2920) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY0002920) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2018-04-11 |