| NPI | 1619029998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 3485) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KY 303) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2016-02-15 |