| NPI | 1083917512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 7111) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WV 1006) |
| 103T00000X Psychologist (Licence: WV 1006) | |
| Enumeration Date | 2010-12-06 |
| Last Update Date | 2014-04-09 |