| NPI | 1467764258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162897) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2507548) |
| 101YM0800X Counselor, Mental Health (Licence: KY 299499) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2026-04-28 |