| NPI | 1376062992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH s.1802660) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161932) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH lcdc.161605) | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2024-08-05 |