| NPI | 1427462373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 991715) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C-0006302) |
| 104100000X Social Worker (Licence: OH S-0015211) | |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2014-06-19 |