| NPI | 1104155118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OH 3261) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 3261) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2009-12-22 |