| NPI | 1780101758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001220) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004842) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2017-08-29 |