| NPI | 1649321324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E0002540-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S12092) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 081074) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-06-12 |