| NPI | 1992757769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OH 4377) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 4377) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: OH 4377) | |
| 103TC0700X Psychologist, Clinical (Licence: OH 4377) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: OH 4377) | |
| 103TC1900X Psychologist, Counseling (Licence: OH 4377) | |
| 103TE1100X Psychologist, Exercise & Sports (Licence: OH 4377) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: OH 4377) | |
| 103TH0004X Psychologist, Health (Licence: OH 4377) | |
| 103TH0100X Psychologist, Health Service (Licence: OH 4377) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: OH 4377) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2010-12-08 |