| NPI | 1043248644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY 1000756) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 05164) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2012-10-15 |