| NPI | 1285012088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161377) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.110371) |
| 104100000X Social Worker (Licence: OH S.1400321-TRNE) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2024-07-02 |