| NPI | 1790549129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.190979) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.186720) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.169960) | |
| 101YM0800X Counselor, Mental Health (Licence: OH QMHS.HS) | |
| Enumeration Date | 2024-02-07 |
| Last Update Date | 2024-12-19 |