| NPI | 1467595819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 933439) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OH 3237) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |