| NPI | 1962685669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.6612) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OH 6612) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2020-10-29 |