| NPI | 1407445075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCII.161853) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH QMHS.HS) |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2024-12-02 |