| NPI | 1033204003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000337) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810003461) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-03-04 |