| NPI | 1336596634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.171962) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN.142684-M-IV) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2019-12-30 |