| NPI | 1922277342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E1901092SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC021219) |
| 101YP2500X Counselor, Professional (Licence: OH E1901092) | |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2022-04-07 |