| NPI | 1760543979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005264) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WY 395) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-12-13 |