| 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 |