| NPI | 1366683815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 2201) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1401) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2009-03-13 |