| NPI | 1164590923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6742) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 03841) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2019-04-02 |