| NPI | 1497192371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH P.7411) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH P.7411) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2025-04-10 |