| NPI | 1841824786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY.0005023) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TF0200X Psychologist Forensic | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2020-03-01 |
| Last Update Date | 2023-08-11 |