| NPI | 1225045875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E3028) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E3028) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH E3028) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-07-26 |