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 |