| NPI | 1174656714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 82822) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E1396) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2025-09-11 |