| NPI | 1245407055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 2602) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AZ 212) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2008-05-15 |