| NPI | 1295232171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.168212) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH QMHS) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2023-09-22 |