| NPI | 1124428511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E. 0800410) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 111050) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2023-10-03 |