| NPI | 1164402749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: OH P.6294) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E 0001957) |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC1900X Psychologist Counseling (Licence: OH 6294) | |
| 103TF0000X Psychologist Family | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| 103TR0400X Psychologist Rehabilitation | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-11-05 |