| NPI | 1336686120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901425) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.162568) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.1500925) | |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2020-05-13 |