| NPI | 1922563535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2208159) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2024-11-26 |