| NPI | 1457867384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1901140-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CS.00001827) |
| 101YP2500X Counselor, Professional (Licence: OH C.1500716) | |
| Enumeration Date | 2017-12-14 |
| Last Update Date | 2024-04-15 |