| NPI | 1366823163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA PSY10000937) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1500716) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2025-01-03 |