| NPI | 1114418720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2203196) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.167222) |
| 101YP2500X Counselor, Professional (Licence: OH C.2002915) | |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2023-12-05 |