| NPI | 1982064259 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH 1400648) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 150555) |
| Enumeration Date | 2016-03-01 |
| Last Update Date | 2016-03-01 |