| NPI | 1548852304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08573) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH P.08573) |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2026-03-26 |