| NPI | 1780283317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 161648) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-10-24 |
| Last Update Date | 2025-10-14 |