| NPI | 1275624116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E4318) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |