| NPI | 1407256662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH E2608) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E2608) |
| 101YP2500X Counselor Professional (Licence: OH E2608) | |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2014-08-25 |