| NPI | 1659868941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2305166-TRNE) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162407) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2023-09-05 |