| NPI | 1285652842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1000762) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810-002503) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2015-07-30 |