| NPI | 1316438500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08201) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH NA) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2022-04-05 |