| NPI | 1437150968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 84049) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: PA 3293) |
| 103TC1900X Psychologist, Counseling (Licence: OH 3448) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2007-07-08 |