| NPI | 1447864145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 174347) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH CDCA.174347) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2021-04-12 |