| NPI | 1164614103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6733) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E2705) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2016-02-10 |