Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3017 | OH |
Y | 103T00000X | Psychologist | 3017 | OH |
NPI | 1003080359 |
---|---|
Provider Name | Gerald B Powell |
First Address | Cincinnati, OH 45237-5126 |
Second Address | Cincinnati, OH 45237-5126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |