| NPI | 1972652030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E0000569) |
| Additional Taxonomies | 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: OH RN133996) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |