| NPI | 1255675948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001012) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810-004805) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2019-09-06 |