| NPI | 1245560176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 01899) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY 1398) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810001175) | |
| Enumeration Date | 2009-12-25 |
| Last Update Date | 2009-12-25 |