| NPI | 1992243851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 7533) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OH 7533) |
| 103TF0200X Psychologist, Forensic (Licence: OH 7533) | |
| 103TH0004X Psychologist, Health (Licence: OH 7533) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 7533) | |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2018-01-16 |