| NPI | 1053077743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.180588) |
| 156F00000X Technician/Technologist | |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2023-09-20 |