| NPI | 1609913565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1874) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 03047) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-09 |