| NPI | 1740877125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: OH 162708) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 0010554) |
| 101YM0800X Counselor, Mental Health (Licence: FL 2233) | |
| 405300000X Prevention Professional (Licence: FL 0802589) | |
| Enumeration Date | 2020-12-31 |
| Last Update Date | 2025-09-15 |