| NPI | 1336699909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0009538) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH I.9538) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 964525) | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2021-04-09 |