| NPI | 1659382026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 944019) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH E2094) |
| 103TC1900X Psychologist Counseling (Licence: OH 5944) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |