| NPI | 1225552078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.162094) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCII.161323) |
| 101YP2500X Counselor Professional (Licence: OH 2204598) | |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2022-09-14 |