| NPI | 1508115908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.07746) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MD P.07746) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2026-03-27 |