NPI | 1992355481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161843) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2204755) |
Enumeration Date | 2019-09-17 |
Last Update Date | 2025-07-18 |