| NPI | 1417300047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.923234) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0004654) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2019-12-27 |