NPI | 1396258117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.167906) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 162442) |
261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: OH QMHS) | |
Enumeration Date | 2017-11-15 |
Last Update Date | 2023-02-07 |