| NPI | 1245646421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001340) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810005872) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-06-14 |