| NPI | 1154359016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810001802) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1451) |
| 103TC0700X Psychologist, Clinical (Licence: MD 02890) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-08 |