| NPI | 1942821590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCII.161809) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.173338) |
| 101YM0800X Counselor Mental Health (Licence: OH QMHS) | |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2023-02-15 |