| NPI | 1306253539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1100082) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDC.131230-3) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2021-11-29 |