| NPI | 1720129794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.7116) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY17037) |
| Enumeration Date | 2007-02-10 |
| Last Update Date | 2024-04-02 |