| NPI | 1083079800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.220289) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.141264) |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2024-02-16 |