| NPI | 1215461637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162993) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2607960) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2026-04-03 |