| NPI | 1972271716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY.0005830) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 32822) |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2022-09-27 |