| NPI | 1689185563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.0028652) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH 021148) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2018-03-17 |