NPI | 1386796688 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3063) |
Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OH 3063) |
103TF0200X Psychologist Forensic (Licence: OH 3063) | |
Enumeration Date | 2007-01-17 |
Last Update Date | 2007-07-08 |