| NPI | 1386167807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2103279) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.616357) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2023-02-23 |