| NPI | 1346740156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH C.1801021) |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2022-11-21 |