| NPI | 1902436199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.172829) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH RA.162195) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2020-02-14 |