| NPI | 1790879658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 4991) |
| Additional Taxonomies | 103TH0100X Psychologist Health Service (Licence: OH 4991) |
| 103T00000X Psychologist (Licence: OH 4991) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-03-04 |