| NPI | 1033688742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH S.1802280) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161777) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2018-11-26 |