| NPI | 1447576012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S0018819) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 081251) |
| Enumeration Date | 2010-04-08 |
| Last Update Date | 2010-04-08 |