| NPI | 1902315542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161544) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2203227) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2023-02-23 |