| NPI | 1508062597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E 0004259) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 031054) |
| 101YM0800X Counselor, Mental Health (Licence: E 0004529) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2024-05-22 |