| NPI | 1568683225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04295) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1000380) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2012-01-06 |