| NPI | 1508370644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161953) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161450) |
| 101YM0800X Counselor, Mental Health (Licence: OH C2103236) | |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2022-03-02 |