| NPI | 1740255132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 3282) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 3282) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: OH 3282) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: OH 3282) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2023-01-25 |