| NPI | 1669998084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2505004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162801) |
| 101YP2500X Counselor, Professional (Licence: OH C1600582) | |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2025-04-17 |