| NPI | 1255658803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 061034) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH C.P0600616) |
| 101YP2500X Counselor, Professional (Licence: OH 232596) | |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2010-04-22 |