Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 3167 | OH |
NPI | 1750554473 |
---|---|
Provider Name | Dr. Bruce Steven Growick |
First Address | Worthington, OH 43085-3466 |
Second Address | Columbus, OH 43085-3466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2008 |
Last Update Date | 03/04/2008 |