| NPI | 1992040133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY.0005439) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY 8141) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2026-01-09 |