| NPI | 1740914365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY200001366) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 07067) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810007862) | |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2024-02-20 |