| 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 |