| NPI | 1972992717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH LICDC.161806) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 141262) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2019-04-25 |