NPI | 1982757076 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH SP157) |
Additional Taxonomies | 103TS0200X Psychologist, School (Licence: OH SP157) |
Enumeration Date | 2007-01-19 |
Last Update Date | 2025-09-11 |