| NPI | 1619948957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH I-0001444) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH I-0001444) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-07-08 |