| NPI | 1336244086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E. 0501309) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH F. 0500052) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDC.131092) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2013-10-08 |