NPI | 1871827972 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0500145-S) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDClll.071001) |
Enumeration Date | 2009-09-23 |
Last Update Date | 2019-05-28 |