| NPI | 1164458972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: UT 11351485-2501) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5437) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2025-01-13 |