| NPI | 1427574748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: OH 161717) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 161717) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: OH 161717) | |
| 101YM0800X Counselor, Mental Health (Licence: OH 161717) | |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2026-10-13 |