| NPI | 1033464201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 913016) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C 1100150) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2014-03-25 |