| NPI | 1376695148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20040753A) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 4661) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-08 |