| NPI | 1871774240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO 3157) |
| Additional Taxonomies | 103TH0004X Psychologist Health (Licence: CO 3157) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CO 3157) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: CO 3157) | |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2024-05-30 |