| NPI | 1104975432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 965628) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E-2452) |
| 101YP2500X Counselor Professional (Licence: OH E-2452) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |