NPI | 1093846222 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000141) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 04040) |
Enumeration Date | 2007-03-08 |
Last Update Date | 2018-06-27 |