| NPI | 1376770610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 6779) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 019167) |
| Enumeration Date | 2009-06-13 |
| Last Update Date | 2011-07-20 |