| NPI | 1497050447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E1000186SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC111079) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2019-09-18 |