| NPI | 1659865566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 170677) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 167478) |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2019-06-18 |