| NPI | 1154835007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 0100569) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 162613) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 0000214) | |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2025-01-06 |