| NPI | 1518518000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 179832) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 1901092) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2022-07-28 |