| NPI | 1568608289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 975919) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH S0022389) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2008-12-30 |