| NPI | 1710269147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0003727) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 33891) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2023-08-07 |