| NPI | 1518124635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3538) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CO 3101) |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2008-05-16 |