| NPI | 1952950651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 90460) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH 0501168) |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2019-09-05 |