| NPI | 1760248421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019605) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH P.08271) |
| Enumeration Date | 2024-02-21 |
| Last Update Date | 2024-03-01 |