| NPI | 1659624039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P08399) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 25249) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2023-02-08 |