| NPI | 1548606940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 7319) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: FL PY8706) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2016-12-28 |