| NPI | 1831398460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CO 3485) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 103T00000X Psychologist (Licence: CO PSY-3485) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2016-02-12 |