| NPI | 1780133645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 923314) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH OCPC.0675) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2023-10-23 |