| NPI | 1053775478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 140635) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2019-03-06 |