| NPI | 1255876009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1800786) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 161118) |
| 101YM0800X Counselor, Mental Health (Licence: OH C 1300768) | |
| 101YM0800X Counselor, Mental Health (Licence: KY 270987) | |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2023-09-04 |