| NPI | 1346636701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162126) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0031146) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2021-04-30 |