NPI | 1205987468 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 1858) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 1858) |
103TC1900X Psychologist, Counseling (Licence: OH 1858) | |
103T00000X Psychologist (Licence: OH 1858) | |
Enumeration Date | 2007-01-15 |
Last Update Date | 2007-07-08 |