| NPI | 1972163483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2002421) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.169941) |
| 101YP2500X Counselor, Professional (Licence: OH C.1901539-TRNE) | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2022-05-06 |