| NPI | 1750414843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 081001210) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC psy 1351) |
| 103T00000X Psychologist (Licence: VA 081001210) | |
| 103T00000X Psychologist (Licence: DC psy 1351) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: VA 081001210) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: DC psy 1351) | |
| 103T00000X Psychologist (Licence: DC psy1351) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |