| NPI | 1467057570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 175161) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2103668-TRNE) | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2023-04-26 |