| NPI | 1497285654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162206) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 1700713) |
| 104100000X Social Worker (Licence: OH S.1700713) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2021-12-01 |