| NPI | 1376653774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OH 7370) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OH P.7370) |
| 103T00000X Psychologist (Licence: MA 7134) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-01-13 |