| NPI | 1346404324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C.0501075-CR) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH C.0501075-CR) |
| 101YM0800X Counselor Mental Health (Licence: OH C.0501075-CR) | |
| Enumeration Date | 2008-07-18 |
| Last Update Date | 2008-07-18 |