| NPI | 1124269519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH CO880109) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 98119) |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2009-03-13 |