| NPI | 1457300907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E0002867) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH E0002867) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 954224) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2013-03-12 |