NPI | 1982117107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 164471) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS3) |
Enumeration Date | 2017-11-09 |
Last Update Date | 2018-11-20 |