| NPI | 1144774100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0002983-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.923162) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2018-06-08 |