| NPI | 1851834089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.172768) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist (Licence: OH 1828893) |
| 146N00000X Emergency Medical Technician, Basic (Licence: OH 156613) | |
| Enumeration Date | 2016-11-19 |
| Last Update Date | 2020-02-04 |