| NPI | 1922724681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.191744) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH 2022) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: OH QMHS) | |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2025-04-08 |