| NPI | 1336667336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant (Licence: OH 0441283) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161340) |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2021-05-10 |