NPI | 1093796377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 3789) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 3789) |
Enumeration Date | 2005-11-14 |
Last Update Date | 2020-06-15 |