| NPI | 1568629400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E0001096) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.923343) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2016-11-29 |