| NPI | 1114332509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1001024) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001024) |
| 103TC1900X Psychologist, Counseling (Licence: MN LP5580) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2022-07-21 |