| NPI | 1962087494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C.2405978) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.175348) |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2024-05-23 |