| NPI | 1861436750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OH 2564) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 2564) |
| 103TF0200X Psychologist, Forensic (Licence: OH 2564) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 2564) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-08-30 |