| NPI | 1093846222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04040) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810007669) |
| 103TC0700X Psychologist, Clinical (Licence: MA PSY10001964) | |
| 103TC0700X Psychologist, Clinical (Licence: DC PSY1000141) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2026-06-21 |