| NPI | 1700444676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2303572) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1901780-TRNE) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YP2500X Counselor, Professional (Licence: OH C.2002530) | |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2023-12-27 |