| NPI | 1073675203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY 1350) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 02397) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS015332) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-09 |