| NPI | 1689067720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.07996) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: OH P.07996) |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2019-12-19 |