| NPI | 1699877118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 3936) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 3936) |
| 103T00000X Psychologist (Licence: OH 3936) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OH 3936) | |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2007-07-08 |