| NPI | 1851795272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: OH SP.00650) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH OH3100126) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2020-03-10 |