| NPI | 1770530073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MO 2001001741) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 950) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-09-30 |