| NPI | 1609972017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 7071) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I7623) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2017-04-15 |