| NPI | 1477800282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 019374) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1001102) |
| 103T00000X Psychologist (Licence: VA 0810008065) | |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2025-05-02 |