| NPI | 1154398584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 6133) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 6133) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 6133) | |
| 103TC1900X Psychologist, Counseling (Licence: OH 6133) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OH 6133) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2021-04-05 |