| NPI | 1801672753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH 0CPSA.161525) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 164920) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2023-09-06 |