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 |