| NPI | 1174641559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810003497) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DC PSY1000301) |
| 103TC0700X Psychologist Clinical (Licence: MD 04362) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2011-07-07 |