| NPI | 1588488878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH cdca.190354) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH APS.005031) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2024-11-13 |