| NPI | 1477726768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 923193) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S-8555) |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2016-12-16 |