| NPI | 1548809924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1001359) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810003601) |
| 103T00000X Psychologist (Licence: MD 05988) | |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2020-01-02 |