| NPI | 1255351912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 976190) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E-2031) |
| 104100000X Social Worker (Licence: OH S-14556) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |