NPI | 1689172967 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.2102107-SUPV) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.110863) |
Enumeration Date | 2018-01-31 |
Last Update Date | 2023-07-19 |