| NPI | 1497865430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003320) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC psy1000358) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-09-17 |