| NPI | 1245747427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.163105) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.1900837-TRNE) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2019-10-22 |