| NPI | 1871095950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor School (Licence: OH C.2507031-TRNE) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: OH 401880740716) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.193137) | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2025-08-13 |