| NPI | 1104509835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.08508) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 274023) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2024-10-21 |