| NPI | 1245588375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1300003-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161660) |
| 101YP2500X Counselor, Professional (Licence: OH LE-00019042) | |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2020-03-26 |