| NPI | 1699972323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0004234) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 79411) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2022-07-28 |