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