NPI | 1124673181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251S00000X Community/Behavioral Health |
Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: OH CDCA.171297) |
Enumeration Date | 2019-08-07 |
Last Update Date | 2019-08-20 |