| NPI | 1962648337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.09024) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: SC 1461) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2026-09-10 |