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 |