| NPI | 1518775667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.191569) |
| Additional Taxonomies | 376J00000X Homemaker |
| Enumeration Date | 2024-12-20 |
| Last Update Date | 2025-03-10 |