| NPI | 1972112217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OH 33.024863) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2023-01-11 |