NPI | 1912078296 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 040115) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH S-0600551) |
Enumeration Date | 2006-11-10 |
Last Update Date | 2007-07-08 |