| NPI | 1417984717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E4376) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 991594) |
| 101YP2500X Counselor, Professional (Licence: OH E4376) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2008-05-07 |