| NPI | 1487142857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161820) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA165216) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.1800799-TRNE) | |
| 106H00000X Marriage & Family Therapist (Licence: OH M.2100176) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2022-02-18 |