| NPI | 1558439513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OH 6111) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: OH 6111) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-01-18 |