| NPI | 1164807277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OH 4616) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 4616) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |