| NPI | 1417225475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E-0900188) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC-111093) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2016-02-24 |