| NPI | 1295199636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 021097) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S 1002048) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-12-11 |