| NPI | 1669831962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E. 0602045) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 131040) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |