| NPI | 1023227469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 2831) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: OH 2831) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2012-10-25 |