| NPI | 1881094480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 7191) |
| 103TC0700X Psychologist, Clinical (Licence: OH 7191) | |
| 103TC1900X Psychologist, Counseling (Licence: OH 7191) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 7191) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: OH 7191) | |
| 103TF0000X Psychologist, Family (Licence: OH 7191) | |
| 103TF0200X Psychologist, Forensic (Licence: OH 7191) | |
| 103TH0004X Psychologist, Health (Licence: OH 7191) | |
| 103TH0100X Psychologist, Health Service (Licence: OH 7191) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: OH 7191) | |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2019-04-11 |