| NPI | 1497123822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E1000551) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 131176) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2015-09-02 |