| NPI | 1376716613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.0022020) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 981013) |
| 104100000X Social Worker (Licence: OH S.0022020) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |