| NPI | 1154482644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1789) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810002098) |
| 103TC0700X Psychologist, Clinical (Licence: MD 03197) | |
| 103TF0200X Psychologist, Forensic (Licence: VA 0810002098) | |
| 103TF0200X Psychologist, Forensic (Licence: DC PSY1789) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |