| NPI | 1598866733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 041051) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 5977) |
| 106H00000X Marriage & Family Therapist (Licence: OH F052) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |