| NPI | 1770048696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162627) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2305696) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2024-12-23 |