| NPI | 1437662418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.121047) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2021-02-25 |