| NPI | 1750994356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2103410) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C2202527TRNE) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA172212) | |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2021-06-18 |