| NPI | 1265602148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000075) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810001688) |
| 103TC0700X Psychologist, Clinical (Licence: MD 02616) | |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2008-03-06 |