| NPI | 1326575119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.82785) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CS-R.82785) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CS.00000375) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-09-28 |