| NPI | 1750506408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003652) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 04432) |
| 103TC0700X Psychologist, Clinical (Licence: DC PSY1000449) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2016-10-27 |