NPI | 1871165670 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OH CDCA.177534) |
Additional Taxonomies | 251S00000X Community/Behavioral Health |
Enumeration Date | 2021-07-13 |
Last Update Date | 2021-07-13 |