| NPI | 1255843090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2203449) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH Lcdc.161453) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCD.090576) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161928) | |
| 101YM0800X Counselor, Mental Health (Licence: OH QMHS) | |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2022-04-04 |