| NPI | 1568875516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.0600906) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH ICDC.981029-CS) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 0503) | |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2014-06-07 |