| NPI | 1598910739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH S0027564) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH S.0027564) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 970016) | |
| Enumeration Date | 2008-12-01 |
| Last Update Date | 2022-04-07 |