| NPI | 1205260643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1000889) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810001238) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2013-08-21 |