| NPI | 1053967240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2005412) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162479) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2024-05-29 |