| NPI | 1508554569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.184226) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| Enumeration Date | 2023-04-27 |
| Last Update Date | 2026-05-28 |