| NPI | 1053035485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2405630-TRNE) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.181730) |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2024-06-03 |