| NPI | 1073892972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6958) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: OH OH6958) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2019-04-01 |