| NPI | 1366406738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810001850) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1000340) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2013-02-01 |