| NPI | 1912412966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 168419) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 164931) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2019-06-17 |