| NPI | 1669911285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161401) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.121091) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.121091) | |
| 101YP2500X Counselor, Professional (Licence: OH E.2303715) | |
| 101YP2500X Counselor, Professional (Licence: OH C.1600018) | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2023-08-14 |