| NPI | 1114387685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2303364) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2003043) |
| 101YM0800X Counselor, Mental Health | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 1312443) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162045) | |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2023-05-02 |