| NPI | 1134639966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901270-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161917) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2025-06-05 |