| NPI | 1558123927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.187599) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2405489-TRNE) |
| Enumeration Date | 2024-01-30 |
| Last Update Date | 2024-05-07 |