| NPI | 1639631617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162176) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161660) |
| 101YM0800X Counselor, Mental Health (Licence: OH c.2204415) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.170438) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-11-08 |