| NPI | 1427563592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 167037) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 163707) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2019-06-21 |