| NPI | 1033397427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.131019) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401011844) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2021-08-05 |