| NPI | 1225572878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161314) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2002402) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2021-01-07 |