| NPI | 1699285882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 161647) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH 121068) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2019-08-08 |