| NPI | 1528546470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.183565) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 166916) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2023-02-28 |