| NPI | 1710284831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: OH OTA. 04593) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2024-01-24 |