| NPI | 1346777141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.852156) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: DE 2053) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-12-22 |