| NPI | 1952865024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children (Licence: OH C.1901664) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1901664) |
| Enumeration Date | 2019-01-23 |
| Last Update Date | 2019-01-23 |