| NPI | 1982122743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH CDCA.170840) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2023-02-20 |