| NPI | 1609909753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 6578) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OH 6578) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-01-04 |