| NPI | 1174030928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY11373) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH P.08142) |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2022-01-20 |