| NPI | 1609381912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2606680) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH C.1801578) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161467) | |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2026-03-09 |