| NPI | 1528429123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH S0901027) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2018-08-03 |