| NPI | 1962526384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 02965) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: DC PSY1685) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |