| NPI | 1326606526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162763) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2406656) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2025-02-11 |