| NPI | 1972231736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 190959) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OH 190959) |
| 171M00000X Case Manager/Care Coordinator (Licence: OH 190959) | |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2025-01-08 |