| NPI | 1730532078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E-1800516) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 1400145) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 161497) | |
| 101YM0800X Counselor Mental Health (Licence: OH 1400145) | |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2020-10-02 |