| NPI | 1376592790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 5706) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OH 5706) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2024-09-16 |