| NPI | 1619972767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 179) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5576) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2022-12-28 |