| NPI | 1679715155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH P.07877) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IN 20042303A) |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2019-06-03 |