| NPI | 1700826765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 5328) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: OH 5328) |
| 103TC0700X Psychologist, Clinical (Licence: OH 5328) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2007-07-08 |