| NPI | 1992168488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2102369) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.131521) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.1400208) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2021-07-13 |