| NPI | 1093214405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.167438) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 164054) |
| 101YM0800X Counselor, Mental Health (Licence: OH QMHS) | |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2023-04-04 |