| NPI | 1306106711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 2681) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 1772) |
| 103T00000X Psychologist (Licence: DC 1625) | |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2012-05-18 |