| NPI | 1225869076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSYA200001316) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810008804) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2025-06-27 |