| NPI | 1093269292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E0602167) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 081152) |
| 101YM0800X Counselor, Mental Health (Licence: OH E0602167) | |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2016-08-05 |