| NPI | 1043672496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: OH I2203490) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC.161097) |
| 104100000X Social Worker (Licence: WV AP00943993) | |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2203490) | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2023-07-18 |