NPI | 1871295014 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH CDCA.185166) |
Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2023-03-21 |
Last Update Date | 2023-08-16 |