| NPI | 1417480195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 965723) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S-0015831) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |