| NPI | 1154560472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000493) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004036) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2011-11-14 |