| NPI | 1205340718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.0029313) |
| Additional Taxonomies | 101Y00000X Counselor |
| 175T00000X Peer Specialist (Licence: OH 000240) | |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2021-08-17 |