| NPI | 1033795737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404872) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2103230) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.176737) | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2025-07-01 |