| NPI | 1013403211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2204597) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.150229) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.2204597) | |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2024-10-20 |