| NPI | 1780837278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000965) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 05342) |
| 103TC0700X Psychologist, Clinical (Licence: KS 2003) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2015-09-02 |