| NPI | 1659966737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 181032) |
| Additional Taxonomies | 251C00000X |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2022-10-06 |