| NPI | 1720434145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OH C2002994387) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH 463081342) |
| 101YM0800X Counselor, Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: WA C2002994387) | |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2026-08-13 |