| NPI | 1700319498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.161406) |
| Additional Taxonomies | 104100000X Social Worker (Licence: S1501405) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2017-04-10 |