| NPI | 1003408394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162574) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.177223) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161796) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.174159) | |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2023-09-22 |