| NPI | 1225262405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH E0003908) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2018-08-22 |