| NPI | 1760567713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CO PSY.0002596) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0002596) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2020-12-23 |