| NPI | 1376758565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 4361) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 4631) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 4631) | |
| 103TC0700X Psychologist, Clinical (Licence: OH 4631) | |
| 103TF0000X Psychologist, Family (Licence: OH 4631) | |
| 103TF0200X Psychologist, Forensic (Licence: OH 4631) | |
| 103TH0004X Psychologist, Health (Licence: OH 4631) | |
| 103TH0100X Psychologist, Health Service (Licence: OH 4631) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 4631) | |
| 106H00000X Marriage & Family Therapist (Licence: OH 4631) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2016-07-15 |