| NPI | 1285149658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161734) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2017-12-07 |
| Last Update Date | 2020-11-19 |