| NPI | 1891132403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 954256) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.020723 NR) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2017-01-03 |