| NPI | 1265952105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P07979) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: CA 2012888) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2021-11-22 |