| NPI | 1306277637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0003119 SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH E0003119 SUPV) |
| 101YM0800X Counselor, Mental Health (Licence: OH E0003119 SUPV) | |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2013-12-12 |