| NPI | 1255838637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.167622) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.164271) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-10-17 |