| NPI | 1932404423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 04017) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1000581) |
| 103T00000X Psychologist (Licence: NY 015740-1) | |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2011-01-14 |