| NPI | 1932392024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161908) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1801353) |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2020-03-26 |