| NPI | 1881767978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DC psy1000137) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 05135) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-01-21 |