| NPI | 1942320858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E-0001965) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH E-0001965) |
| 101YM0800X Counselor, Mental Health (Licence: OH E-0001965) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2018-11-05 |