| NPI | 1124402441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08886) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2025-11-13 |