| NPI | 1730954264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OH P.08584) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2024-02-06 |