| NPI | 1972604387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 01935) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000182) |
| 103TC0700X Psychologist, Clinical (Licence: DE B1-0000658) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810003244) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2009-09-30 |