| NPI | 1386150134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.175360) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor | |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2024-06-13 |