| NPI | 1578501839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 279929) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 121053) |
| 101YM0800X Counselor, Mental Health (Licence: OH E.1700098) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-11-22 |