| NPI | 1104565183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY200001324) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810007802) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2022-05-31 |