| NPI | 1174076350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1901094) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH c.1500509) |
| 101YM0800X Counselor, Mental Health (Licence: OH c.1500509) | |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2020-08-27 |