| NPI | 1174159610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.174383) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-09-01 |