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 |