| NPI | 1225199912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.0600256-S) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC.131090-S) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH22429) | |
| 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020296) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2024-06-11 |