| NPI | 1639563844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1100455.SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.141206) |
| 101YM0800X Counselor, Mental Health (Licence: OH E.1100455.SUPV) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2017-02-09 |