| NPI | 1285309096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2308896) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH CDCA.140665) |
| 101YM0800X Counselor, Mental Health (Licence: OH QMHS) | |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2023-03-15 |