| NPI | 1265814123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH OCPS.1178) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 090235) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2023-09-06 |