| NPI | 1467818641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08315) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OR 22426) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2023-06-12 |