| NPI | 1346228020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1480) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 2464) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810001596) | |
| 103TF0200X Psychologist, Forensic (Licence: DC PSY1480) | |
| 103TF0200X Psychologist, Forensic (Licence: MD 2464) | |
| 103TF0200X Psychologist, Forensic (Licence: VA 0810001596) | |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-07-08 |