| NPI | 1376055095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P07638) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY8880) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2017-11-06 |