| NPI | 1932609211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C.2204660) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.162355) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2025-06-12 |