| NPI | 1205941648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3172) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 3172) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 3172) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-06-10 |