| NPI | 1285665166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810007882) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5983) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-10-24 |