| NPI | 1952649477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.1100287) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH C.1100287) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.110594) | |
| Enumeration Date | 2013-01-17 |
| Last Update Date | 2013-12-31 |