| NPI | 1659430759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 1628) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: OH 1628) |
| 103G00000X Clinical Neuropsychologist (Licence: OH 1628) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: OH 1628) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |