| NPI | 1265957914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH C.1700611) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional (Licence: OH C.1700611) | |
| 102L00000X Psychoanalyst (Licence: OH 11725) | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2025-01-05 |