| NPI | 1467465609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: OH 4585) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 4585) |
| 103TC1900X Psychologist, Counseling (Licence: OH 4585) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 4585) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2016-01-20 |