| NPI | 1063616795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E. 0016706) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0016706) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 882422-CS) | |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2016-03-11 |