| NPI | 1679570337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E-1796) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 923381) |
| 101YP2500X Counselor, Professional (Licence: OH E-1796) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2021-08-23 |