| NPI | 1790701662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH Cdca.179941) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35-05-6037-C) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2022-07-14 |