| NPI | 1982669180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 5707) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OH 5707) |
| 103T00000X Psychologist (Licence: CO 2394) | |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2013-07-16 |