| NPI | 1225521743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.167012) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2021-02-25 |