| NPI | 1235206434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH ICAOC22266) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 976085) |
| 101YP2500X Counselor, Professional (Licence: OH E0002538) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2023-05-09 |