| NPI | 1285357145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSYA200001263) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC LGPC200001720) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2024-03-12 |