| NPI | 1669995304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.1700216) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 151249) |
| Enumeration Date | 2017-07-25 |
| Last Update Date | 2021-12-22 |