| NPI | 1649786633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.170905) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 167186) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2021-01-27 |