| NPI | 1528117645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH OH4823) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH OH4823) |
| 103TH0100X Psychologist, Health Service (Licence: OH OH4823) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2008-05-23 |