| NPI | 1124412846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.002550-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC.84168-CSSR) |
| 104100000X Social Worker (Licence: OH S.0009491) | |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-04-06 |