| NPI | 1447823257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 39590) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH P.08251) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2023-01-31 |