| NPI | 1972775849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OH 4593) |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: OH 4593) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-03-31 |