| NPI | 1316486145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 2640) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20042424A) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2017-02-13 |