| NPI | 1679102511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 05891) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001413) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2020-04-03 |