| NPI | 1790284560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2505379) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 162455) |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2025-06-08 |