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 |