| NPI | 1801954920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 7285) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 3446-57) |
| 103TC0700X Psychologist, Clinical (Licence: NE 723) | |
| 103TC0700X Psychologist, Clinical (Licence: MS 42692) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-12-14 |