| NPI | 1891469227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.180242) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.176210) |
| 251S00000X (Licence: OH CDCA.1762210) | |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2022-04-04 |