| NPI | 1710765920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 06913) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSYA200001348) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-09-19 |