| NPI | 1689894040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 129177) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 3588) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2016-06-03 |