| NPI | 1245620038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1600045) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1300409) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161054) | |
| Enumeration Date | 2015-01-31 |
| Last Update Date | 2017-02-17 |