| NPI | 1114321817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY2200001392) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810007832) |
| 103TC0700X Psychologist, Clinical (Licence: NC 4672) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2023-10-08 |