| NPI | 1811946387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 5652) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5652) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-03-14 |