| NPI | 1316536725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.2458) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2022-02-14 |