| NPI | 1356433734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 00775) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY886) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: DC PSY886) | |
| 103TF0200X Psychologist, Forensic (Licence: DC PSY886) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: DC PSY886) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2020-08-31 |