| NPI | 1821106600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: OH 3294) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: NJ 1650) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |