| NPI | 1366944522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA160426) |
| Additional Taxonomies | 251S00000X (Licence: OH CDCA.160426) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2018-06-30 |