| NPI | 1477543528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3709) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA 4370L) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA 4370L) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 3709) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2007-07-08 |