| NPI | 1164899738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.07600) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0701156) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS017943) | |
| Enumeration Date | 2015-08-30 |
| Last Update Date | 2017-07-28 |