| NPI | 1134110117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0001981-SUPV) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.964481) |
| 101YP2500X Counselor, Professional (Licence: OH E.0001350-SUPV) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2019-06-24 |