| NPI | 1760790885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.0000448) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH C0000448) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2021-04-20 |