| NPI | 1427610591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH 2106794) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: OH 170095) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2022-01-05 |