| 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 |