| NPI | 1679263156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.184311) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2025-06-27 |