| NPI | 1639387855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 2743) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS002545-L) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2007-07-08 |