| NPI | 1457973687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY200001222) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 003918) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2021-12-29 |