| NPI | 1356891428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH s.0600786) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 131192) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2016-10-12 |