| NPI | 1982951190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 166426) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 121019) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ZZ 710053) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ZZ 128644) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2024-03-22 |