| NPI | 1528482833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: OH OH1233979) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5253) |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2014-02-06 |