| NPI | 1285131268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children (Licence: OH CDCA.165186) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2018-04-06 |