| 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 |