| NPI | 1225787781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.187231) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 187231) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 182925) | |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2024-03-12 |