| NPI | 1306841689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 82782) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH 00000542) |
| 103T00000X Psychologist (Licence: OH 5654) | |
| 1041C0700X Social Worker, Clinical (Licence: OH I0002849) | |
| 1041C0700X Social Worker, Clinical (Licence: KY 0723) | |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2007-07-08 |