| NPI | 1700280294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO 4346) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY4346) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2025-05-15 |