| NPI | 1760994313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0001940) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 1940) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2023-04-28 |