| NPI | 1528113727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 5571) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 5571) |
| 103TH0004X Psychologist, Health (Licence: OH 5571) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2021-11-18 |