| NPI | 1386488138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.08662) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO PSY.0007123) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2026-08-26 |