| NPI | 1194200337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH P.08766) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 4575) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2025-04-01 |