| NPI | 1568546422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 2671) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-05-08 |