NPI | 1366646119 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0500621-SUPV) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 290653) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161898) | |
Enumeration Date | 2007-06-14 |
Last Update Date | 2025-08-19 |