| NPI | 1154282366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.195030) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251B00000X Case Management | |
| Enumeration Date | 2025-11-19 |
| Last Update Date | 2026-01-28 |