| NPI | 1346389418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3458) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OH 3458) |
| 103TF0000X Psychologist Family (Licence: OH 3458) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-09 |