NPI | 1083245468 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 7458) |
Additional Taxonomies | 103T00000X Psychologist (Licence: OH 7458) |
103TF0200X Psychologist, Forensic (Licence: OH 7458) | |
Enumeration Date | 2020-02-04 |
Last Update Date | 2022-01-22 |