| NPI | 1073166385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.175177) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor | |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2021-01-15 |