| NPI | 1437772761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.179687) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2022-02-09 |