| NPI | 1871550434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 758) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH 758) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: OH 758) | |
| 103TC0700X Psychologist, Clinical (Licence: OH 758) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 758) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 758) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: OH 758) | |
| 103TF0000X Psychologist, Family (Licence: OH 758) | |
| 103TF0200X Psychologist, Forensic (Licence: OH 758) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OH 758) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2010-12-08 |