| NPI | 1215756036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 190106) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH 190106) |
| Enumeration Date | 2024-10-08 |
| Last Update Date | 2025-04-04 |