| NPI | 1316481401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: AZ 3535) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 4721) |
| 103TC0700X Psychologist, Clinical (Licence: IN 20040780-A) | |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2016-12-08 |