| NPI | 1619209020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E. 0002046 SUPV) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH E. 0002046 SUPV) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2024-05-30 |