| NPI | 1316153059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: DC PSY1695) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1695) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: DC PSY1695) | |
| 103TC1900X Psychologist, Counseling (Licence: DC PSY1695) | |
| 103TF0000X Psychologist, Family (Licence: DC PSY1695) | |
| 106H00000X Marriage & Family Therapist (Licence: DC PSY1695) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-07-08 |