| NPI | 1316710429 |
|---|---|
| Former Name | SUSAN NICHOLE BARTOSH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1962) |
| Enumeration Date | 2023-10-31 |
| Last Update Date | 2023-10-31 |