| NPI | 1669056065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.183914) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: OH 34251) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2023-04-19 |