| NPI | 1114979341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3027) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 3027) |
| 103TC0700X Psychologist, Clinical (Licence: OH 3027) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: OH 3027) | |
| 103TF0200X Psychologist, Forensic (Licence: OH 3027) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2010-12-14 |