| NPI | 1750706677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH P.07764) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 26269) |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2020-07-04 |