| NPI | 1265973937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C.2002440) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.161969) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2022-03-31 |