| NPI | 1235113697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I0004195) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 852101) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |