| NPI | 1679198840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH cdca.181056) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.176495) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2022-06-29 |