| NPI | 1174694558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 4547) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: OH 4547) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2011-03-20 |