NPI | 1598912610 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: DC PSY1764) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810002613) |
Enumeration Date | 2008-08-20 |
Last Update Date | 2008-08-20 |