| NPI | 1356893515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: OH 35.045682) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 35.045682) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-14 |