NPI | 1356415368 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0001490) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 81648) |
Enumeration Date | 2006-11-20 |
Last Update Date | 2008-12-01 |