| NPI | 1205138427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.151158) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1000255) |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2025-01-21 |