| NPI | 1639605033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001395) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 1556) |
| 103TC0700X Psychologist, Clinical (Licence: NY 022075-1) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2020-12-14 |