| NPI | 1316566474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08007) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH P.08007) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH P.08007) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH P.08007) | |
| 103TH0100X Psychologist, Health Service (Licence: OH P.08007) | |
| Enumeration Date | 2020-04-09 |
| Last Update Date | 2020-04-09 |