| NPI | 1043761059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.150199) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1700263) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2018-05-02 |