| NPI | 1467498113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 3670) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 78002) |
| 1041C0700X Social Worker, Clinical (Licence: OH I0002480) | |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2011-12-13 |