| NPI | 1417498809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 101116) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH 4417) |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2017-03-17 |