| NPI | 1740338144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 79302) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: OH 4190) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |