| NPI | 1013028653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: OH 2187) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 2187) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: OH 2187) | |
| 103TS0200X Psychologist School (Licence: OH 2187) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-10-25 |