| NPI | 1053654517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 061047) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OH 00643) |
| 103K00000X Behavior Analyst (Licence: OH 00121) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2013-04-03 |