| NPI | 1073582953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 35-03-3319 S) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 12001) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |