| NPI | 1265686505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 130771) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 6495) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2026-03-03 |