| NPI | 1437417292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 3107) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019083) |
| 103TC0700X Psychologist, Clinical (Licence: OH P.07817) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2019-09-23 |