| NPI | 1992994503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MD 04024) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY1000259) |
| 103TC0700X Psychologist, Clinical (Licence: MA 3531) | |
| Enumeration Date | 2007-10-19 |
| Last Update Date | 2007-10-19 |