| NPI | 1598340200 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC Psy200001521) | 
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810008255) | 
| Enumeration Date | 2021-03-15 | 
| Last Update Date | 2025-09-30 |