| NPI | 1740386143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: OH 022839750) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 207Q00000X Family Medicine (Licence: OH 35081282) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-02-10 |