| NPI | 1215488911 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ETHAN ROBERT SIEGEL Psychologist 703-819-6177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810004627) |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2016-10-18 |