| NPI | 1558412445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0700182-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E. 0700182) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH Certification 050075) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-11-09 |