| NPI | 1295821171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 08214) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 71006575) |
| 103TC0700X Psychologist, Clinical (Licence: CA 29905) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-09-23 |