| NPI | 1346574142 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 5051) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: OH 5051) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2009-09-25 |