| NPI | 1881809762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 5607) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: IN 20042217A) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2015-03-11 |