| NPI | 1326755729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH M.2400388-TRNE) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.182506) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.186062) | |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2024-05-07 |