| NPI | 1013791144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.188127) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QBHS) |
| 251B00000X Case Management (Licence: OH QBHS) | |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-05-23 |