NPI | 1992137061 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 182762) |
Additional Taxonomies | 103TC1900X Psychologist, Counseling |
Enumeration Date | 2013-07-31 |
Last Update Date | 2023-07-17 |