| NPI | 1801089172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH I0002192) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH I0002192) |
| 101YP2500X Counselor, Professional (Licence: OH I0002192) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2019-07-02 |