| NPI | 1396958286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C0004836) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 943865) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2007-07-08 |