| NPI | 1124563929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 06887) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 3758) |
| Enumeration Date | 2017-01-03 |
| Last Update Date | 2023-04-04 |