| NPI | 1518944271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH AD003542) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 3429) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2025-09-11 |