| NPI | 1881807063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: DC PSY1158) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: DC PSY1158) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2008-01-22 |