| NPI | 1285259804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA-175948) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH CDCA.172222) |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2024-03-19 |