| NPI | 1336269356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 1023) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OH 1023) |
| 103TF0000X Psychologist Family (Licence: OH 1023) | |
| 103TH0100X Psychologist Health Service (Licence: OH 1023) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: OH 1023) | |
| 103T00000X Psychologist (Licence: OH 1023) | |
| 103TS0200X Psychologist School (Licence: OH 1023) | |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2007-07-08 |