| NPI | 1184138075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2103883) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.162740) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161441) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162213) | |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2024-02-06 |