| NPI | 1740763655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LCDCII.161496) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH W.1700030) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2018-09-07 |