| NPI | 1518379106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001557) |
| Additional Taxonomies | 171W00000X Contractor |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2026-03-24 |