| NPI | 1497701395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.2699) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 2699) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2024-11-08 |