| NPI | 1942636436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E0007373) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 981054) |
| 101YP2500X Counselor, Professional (Licence: OH E0007373) | |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2013-09-17 |