| NPI | 1548830680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162311) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2204618) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2025-03-13 |