| NPI | 1578056396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.161370) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH 161370) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2019-04-17 |