| NPI | 1700067477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0600565-SUPV) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C0600565) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.140947) | |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2020-03-19 |