| NPI | 1669176921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.6857) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 6857) |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2024-11-06 |