| NPI | 1255824231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA080510) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2024-11-04 |