| NPI | 1427455120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E 1300796) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 160697) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2016-11-08 |