| NPI | 1457707747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH S.1451263) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 1451263) |
| 101YM0800X Counselor Mental Health (Licence: OH 1451263) | |
| 101YM0800X Counselor Mental Health (Licence: OH S.1451263) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2017-01-04 |