| NPI | 1063435253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.6043) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OH 6043) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2024-01-31 |