| NPI | 1134217532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3496) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: OH 3496) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2015-09-17 |