| NPI | 1205495447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.2102554) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1901957) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162196) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2022-11-03 |