| NPI | 1497260194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH S.1451076) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH S.1451076) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2022-09-14 |