| NPI | 1942638408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E-0501359) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.091022) |
| 101YP2500X Counselor, Professional (Licence: OH E.0501359) | |
| Enumeration Date | 2013-10-21 |
| Last Update Date | 2017-11-05 |