| 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 |