| NPI | 1295882637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000175) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 03688) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810003606) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-08 |