| NPI | 1477072536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1001239) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810004915) |
| Enumeration Date | 2017-09-10 |
| Last Update Date | 2022-07-21 |