| NPI | 1225676471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404448) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1902050-TRNE) |
| 101Y00000X Counselor (Licence: OH E.2404448) | |
| 101YP2500X Counselor, Professional (Licence: OH C.2103430) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CDCA.177666) | |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2026-01-22 |