| NPI | 1134741804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2002927) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1901847-TRNE) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.173308) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-05-15 |
| Last Update Date | 2020-10-15 |