| NPI | 1306148945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 6971) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810008839) |
| Enumeration Date | 2010-12-02 |
| Last Update Date | 2025-03-11 |