| NPI | 1275608101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MD 02651) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DC PSY1347) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2010-11-01 |