| NPI | 1427765924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.189124) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH 189124) |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2024-10-14 |