| NPI | 1790289213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0006202) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2646) |
| 103T00000X Psychologist (Licence: KS 2646) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-01-23 |