| NPI | 1891725024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OH 4800) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: OH 4800) |
| 103TC0700X Psychologist, Clinical (Licence: OH 4800) | |
| 103TH0004X Psychologist, Health (Licence: OH 4800) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 4800) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-04-04 |