| NPI | 1083844617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810-002621) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000011) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2009-07-16 |