| NPI | 1992374714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY.0005677) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: CO 352438) |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2021-11-12 |