| NPI | 1962707828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: OH 725201) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2015-10-21 |