| NPI | 1790907327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC PSY1000361) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD 04212) |
| 103TC0700X Psychologist, Clinical (Licence: DC PSY1000361) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-19 |