| NPI | 1093208357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCIII.162483) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.164958) |
| 104100000X Social Worker (Licence: OH S.2207563) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-03-24 |