NPI | 1861563165 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 2390) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 2390) |
103T00000X Psychologist (Licence: OH 2390) | |
Enumeration Date | 2006-11-10 |
Last Update Date | 2007-07-08 |