| NPI | 1083240550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2202902-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162169) |
| 101YM0800X Counselor, Mental Health (Licence: IN 39004679A) | |
| 101YP2500X Counselor, Professional (Licence: OH E.2202902-SUPV) | |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2024-03-22 |