| NPI | 1639356157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 4765) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 84177) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 4765) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 4765) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 4765) | |
| 103TF0000X Psychologist, Family (Licence: OH 4765) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2014-10-23 |