| NPI | 1275131187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162492) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2305035) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2023-11-17 |