| 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 |