| NPI | 1336105568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6172) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6172) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2020-03-05 |