| NPI | 1932394582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6865) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 23025) |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2012-02-27 |