| NPI | 1861850836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005641) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1001119) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2023-06-26 |