NPI | 1598104044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH 1101526) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 101193) |
Enumeration Date | 2013-06-18 |
Last Update Date | 2014-03-10 |