| NPI | 1417469172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.162504) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LCDCIII.161985) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2023-11-17 |