| NPI | 1053715854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08378) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS017376) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2026-05-12 |