| NPI | 1922164771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WV 1700) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.0002513-SUPV) |
| 101Y00000X Counselor (Licence: OH E-2513) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.091091) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2025-03-21 |