| NPI | 1194721910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TR0400X Psychologist Rehabilitation (Licence: OH 2060) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 2060) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2007-07-08 |