| NPI | 1801493846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005532) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PSY10001531) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2025-10-27 |