| NPI | 1306504618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.194209) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: OH OH3153062) |
| 101YM0800X Counselor, Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2025-11-05 |