| NPI | 1750482956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 2156) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS002919L) |
| 103T00000X Psychologist (Licence: NC 1834) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2017-02-05 |