| NPI | 1568831154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH P.08125) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WV 1058) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2026-02-19 |