| NPI | 1881163988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 168631) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2021-09-10 |