| NPI | 1225056153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.6338) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OH P6338) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-09-11 |