| NPI | 1750654778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC psy1000179) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 1165) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-02-22 |