| NPI | 1992883490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH P.08179) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 8212872-2501) |
| 103TC0700X Psychologist, Clinical (Licence: VT 048.0135267) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-11-25 |