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 |