| NPI | 1508470493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162680) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH S.2410975) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2024-06-11 |