| NPI | 1326189556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 2347) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: OH 2347) |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: OH 2347) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2023-02-28 |