NPI | 1659928190 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08278) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH P.08278) |
103TC2200X Psychologist, Clinical Child & Adolescent | |
Enumeration Date | 2019-08-20 |
Last Update Date | 2022-03-16 |