NPI | 1205307626 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162714) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA168836) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161870) | |
Enumeration Date | 2018-12-11 |
Last Update Date | 2024-06-28 |