| NPI | 1114621679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.188648) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH APS.003978) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.184823) | |
| 101YM0800X Counselor, Mental Health (Licence: OH APS.003978) | |
| Enumeration Date | 2023-03-29 |
| Last Update Date | 2024-12-04 |