| NPI | 1407932296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 021055) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH E 4364) |
| 106H00000X Marriage & Family Therapist (Licence: OH E 4364) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2009-10-07 |