| NPI | 1205307626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162714) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA168836) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161870) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2026-04-07 |