| NPI | 1841562949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH OCPS4486) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII161791) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2018-12-28 |