| NPI | 1366706434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05140) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000824) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2012-10-18 |