| NPI | 1164752309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 944083) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S28730) |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2014-06-27 |