| 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 |