| NPI | 1790828515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 3499) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: SC 856) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2009-10-01 |