| NPI | 1902208549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: OH UA10001907) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: OH UA1001907) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2014-09-25 |