| NPI | 1821683848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: C.2506779) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.174519) |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2025-04-07 |