| NPI | 1346386208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 86419) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E591) |
| 1041C0700X Social Worker, Clinical (Licence: OH 0004221) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-09 |