| NPI | 1104478478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2305419) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162575) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2024-02-08 |