| NPI | 1497192371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 7411) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| 103G00000X Clinical Neuropsychologist | |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2022-03-23 |