NPI | 1861055071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162365) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2305222-TRNE) |
Enumeration Date | 2019-04-15 |
Last Update Date | 2024-06-24 |