| NPI | 1710497052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.07855) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 3397) |
| Enumeration Date | 2017-09-30 |
| Last Update Date | 2019-02-05 |