| NPI | 1689261364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.174251) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH W.2300350) |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2025-10-16 |