| NPI | 1457626038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 4277) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1000398) |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2014-06-03 |