| NPI | 1598383432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162246) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2002608) |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2022-05-03 |